How it is administered

Bortezomib is given either by intravenous (IV) injection or by subcutaneous (under the skin) injection. It is supplied as a powder that is mixed with saline before administration. The recommended starting dose is 1.3 mg/m², and it is typically given as a quick IV push (over 3 to 5 seconds) or as a subcutaneous injection. The dosing schedule and number of cycles depend on the treatment plan, which may include combination with other medications such as melphalan and prednisone. The site of subcutaneous injections should be rotated to minimize skin reactions.

How it works

Bortezomib is a type of medication known as a proteasome inhibitor. Proteasomes are structures inside cells that break down and recycle proteins that are no longer needed. In multiple myeloma, cancerous plasma cells rely on proteasomes to manage the proteins they produce in excess. By blocking the activity of the 26S proteasome, bortezomib causes a buildup of unwanted proteins inside the cell, disrupting normal cell function and triggering cell death. This effect is particularly strong in cancer cells, which are more sensitive to the accumulation of damaged or misfolded proteins. As a result, bortezomib helps to slow or stop the growth of multiple myeloma cells and can shrink tumors or keep the disease under control.

Who Should take it

Bortezomib is indicated for adults with multiple myeloma, a cancer of plasma cells in the bone marrow. It is used both in patients who have not received prior treatment and those whose disease has returned or not responded to previous therapies. Bortezomib can be given alone or in combination with other medications such as melphalan and prednisone. It is also approved for the treatment of mantle cell lymphoma, another type of blood cancer. Your healthcare team will determine if bortezomib is appropriate for you based on your diagnosis, previous treatments, and overall health.

Who should not take it

Bortezomib should not be used in patients who have had a severe allergic reaction (not including local skin reactions) to bortezomib, boron, or mannitol. Signs of a severe allergic reaction can include swelling, difficulty breathing, or anaphylaxis. Bortezomib must never be given into the spinal canal (intrathecal administration), as this can be fatal. Patients with severe pre-existing peripheral neuropathy should only receive bortezomib after careful consideration of the risks and benefits. If you are pregnant, planning to become pregnant, or breastfeeding, you should not take bortezomib due to the risk of harm to the baby.

Commonly used with

Bortezomib is often used in combination with other medications for multiple myeloma. The most common combinations include:

• Melphalan and prednisone (especially for patients who have not received prior treatment)
• Dexamethasone
• Other chemotherapy agents (such as cyclophosphamide, doxorubicin, or rituximab in mantle cell lymphoma)

Your doctor will choose the best combination based on your specific situation and treatment goals.

Commonly tested with

Bortezomib has been tested in clinical studies with:

• Melphalan and prednisone (for newly diagnosed multiple myeloma)
• Dexamethasone (for relapsed or refractory multiple myeloma)
• Rituximab, cyclophosphamide, doxorubicin, and prednisone (for mantle cell lymphoma)

It has also been studied in combination with other chemotherapy regimens and as a single agent in various clinical trials for blood cancers.